The purpose of the Building Research Capacity and Infrastructure (BRIC) proposal is to develop a viable and sustainable rural and frontier health services research program within the University of North Dakota Center for Rural Health (CRH). More specifically, the long term objective of this project is to build the research capacity and infrastructure necessary to improve the quality, safety, efficiency and effectiveness of healthcare for Americans residing in rural and frontier areas. The Agency for Healthcare Research and Quality has indicated that rural and frontier residents are considered priority populations that would benefit from health services research. The CRH proposes a program that will firmly establish a group of rural and frontier health service research leaders at the CRH. The BRIC program will contribute to this goal by providing the opportunity to build the research and infrastructure capacity necessary for multidisciplinary approaches applicable to broad-based health services research. To accomplishthis goal, three nationally recognized rural health experts have agreed to serve as mentors. In addition, partnerships have been developed with nationally recognized entities in rural health services research such as the Upper Midwest Rural Health Research Center (University of Minnesota) and the Great Plains Center for Health Statistics, established by the Rural Policy Research Institute. The CRH will build upon the infrastructure established by its mentors and their respective organizations to examine health services research issues on a state, regional and national basis. The proposed research study design will incorporate two components to examine factors impacting inter-hospital transfers and outcomes in rural and frontier hospitals in North Dakota. The first component will utilize logistic regression analysis to identify factors that significantly impact patient outcome of inter-hospital transfers from rural and frontier hospitals. The second component involves a formative evaluation designed to generate a base line knowledge concerning the transfer decision making process in North Dakota rural and frontier hospitals. A key consideration in the research proposal focuses on aviation and error management issues such as communication, leadership, planning and vigilance as factors that have application to clinicians in rural and frontier hospitals. The knowledge developed through BRIC will be utilized to expand CRH's rural and frontier health services research infrastructure and capacity. [unreadable] [unreadable] . [unreadable] [unreadable]